LONELINESS ACROSS THE LIFE COURSE; LIFE STORY INTERVIEWS WITH MENTAL HEALTH SERVICES USERS

Abstract Introduction The complexity of loneliness and its negative impact on our health and wellbeing is well established. However, the qualitative experience of loneliness over the life course is poorly understood. Method: This presentation, based on 18 life story interviews, with a sample of older adults, who were attending a mental health service and objectively defined as lonely, provides an insight into the personal experiences of loneliness as well as the situations and factors associated with loneliness across the life course. Results The analysis identified three distinct typologies of loneliness; those who experienced (1) chronic loneliness across their life (2) those whose loneliness became chronic after a transition e.g. bereavement (3) those whose loneliness remained situational/transitional. Conclusions The insights are important to inform both general loneliness services and policy as well as specialist mental health services and training. The presentation demonstrates the importance of a life course approach to addressing and understanding loneliness.

person-centred care. Quantifiable measures can provide a gauge of change in practice. However, little is known about how older people themselves perceive independence through time, or whether measures used are commensurate with what matters to older people. This study aimed to identify whether and how older adults assimilate their perceptions of independence in response to change through time. Two semistructured interviews were conducted longitudinally, one year apart, to explore the views of 12 community-dwelling older adults, aged 76-85 years. A constructionist approach using dramaturgical and descriptive codes, facilitated the data interpretation. Sixteen analytical questions guided exploration of participants' perceptions of independence through time. Interview participants felt that common interpretations of independence underestimated, and omitted, important aspects of their experience through time. Some participants questioned the value of instruments that were insensitive to individual values and context. Changes in life trajectories required participants to adapt the form, or means of obtaining independence. The impact of change on participants' sense of independence was value-dependent, informed by the function a participant ascribed to maintaining independence. This study builds on the understanding of independence as a complex and multifaceted construct. The findings challenge the congruence of common interpretations of independence with older people's views, showing areas of commonality and discrepancy. Exploration of independence in terms of form and function provides important understanding about how continuity of function takes precedence to form in determining the maintenance of independence through time.

RE-EXAMINING PATIENT-CENTERED CARE THROUGH DESIGN PROCESS
Kristine Mulhorn 1 , and Shushi Yoshinaga 2 , 1. Drexel University,Wallingford,Pennsylvania,United States,2. Drexel University,Philadelphia,Pennsylvania,United States Service design is the adoption of design process to healthcare and other service sectors. This was a transdisciplinary research project in which investigators were faculty members from Graphic Design and Health Administration. In addition, two student research assistants were recruited from undergraduate Graphic Design and Health Science majors. The objective of service design is to involve consumers, designers, and businesspeople in an integrative process, which can be applied to post-acute rehabilitation hospital settings focusing specifically on the experience of those who are 65 and older. The aim of this pilot study was to explore "designing with people rather than just for them", an approach to improve the patient experience. Our first step involved on-site interviews. The patient narratives raised challenges and positive aspects of their interactions with the facility. On our initial site visit, we interviewed five members of clinicians and administrative staff. During the two follow-up visits, our student research assistants interviewed seven patients. Based on our staff member interview findings, we developed a revised set of questions for patients. The questionnaire was divided into three sections related to appointments: pre-arrival, during the visit, and after their appointments. Interview results were summarized in a visual data format and collaborative recommendations were made during the final presentation such as interior layout, wayfinding, online portal and their functionalities. Our findings also confirmed that the interior signage created confusion, promoting frequent questions to staff. These results will engage stakeholders and contribute to a co-designing process that will ultimately improve the patient journey. The very personal and complex nature of loneliness is too rarely articulated in research papers. Each presenter in this interdisciplinary and international symposium presents insights into loneliness and /or social isolation that can help bridge this gap. Victor (Social Gerontology) using open ended responses from the 2018 BBC Loneliness Experiment, presents how 1480 older people describe loneliness and highlights the need to give more attention to existential loneliness. O'Sullivan (Public Health) presents the results of 18 life story interviews with older adults attending a mental health service. The analysis identified three different typologies of loneliness with specific recommendations for training and services. Phone-based support programs are increasingly being used as a solution for those experiencing loneliness. However, less is known about what aspects are most helpful. Perissinotto (Geriatrics and Palliative care) presents results from 38 qualitative interviews with a focus on barriers and facilitators to implementing a phone-based support intervention, particularly for older adults experiencing loneliness. Cudjoe (Medicine) presents qualitative data from older adults (English, Spanish and Mandarin speaking), living in non-profit affordable housing in 22 different states. Drawing on experiences of their social connections during the COVID-19 pandemic, the paper gives voice to the implications of the loss of common facilities, and opportunities to socialize with other residents, and the increased role technology plays in staying connected. Our discussant, Prof Leavey, a leader in the field of mental health, will reflect on the major themes emerging from these multidisciplinary perspectives, especially what they mean for public health and services.

LONELINESS ACROSS THE LIFE COURSE; LIFE STORY INTERVIEWS WITH MENTAL HEALTH SERVICES USERS
Roger O'Sullivan 1 , Annette Burns 2 , Gerry Leavey 3 , Jeannette Golden 4 , Dermot Reilly 4 , and Brian Lawlor 5 , 1. Institute of Public Health in Ireland,Belfast/Dublin,Ireland,2. Institute of Public Health,Dublin,Dublin,Ireland,3. Ulster University,Belfast,Northern Ireland,United Kingdom,4. Saint James' Hospital,Dublin,Dublin,Ireland,5. Trinity College Dublin,Dublin,Dublin,Ireland Introduction: The complexity of loneliness and its negative impact on our health and wellbeing is well established. However, the qualitative experience of loneliness over the life course is poorly understood. Method: This presentation, based on 18 life story interviews, with a sample of older adults, who were attending a mental health service and objectively defined as lonely, provides an insight into the personal experiences of loneliness as well as the situations and factors associated with loneliness across the life course.
Results: The analysis identified three distinct typologies of loneliness; those who experienced (1) chronic loneliness across their life (2) those whose loneliness became chronic after a transition e.g. bereavement (3) those whose loneliness remained situational/transitional.
Conclusions: The insights are important to inform both general loneliness services and policy as well as specialist mental health services and training. The presentation demonstrates the importance of a life course approach to addressing and understanding loneliness.

HOW DO LONELY OLDER PEOPLE TALK ABOUT LONELINESS? PRELIMINARY ANALYSIS OF THE BBC LONELINESS EXPERIMENT
Christina Victor 1 , Manuela Barreto 2 , and Pamela Qualter 3 , 1. Brunel University London,London,England,United Kingdom,2. University of Exeter,Exeter,England,United Kingdom,3. University of Manchester,Manchester,England,United Kingdom Three types of loneliness, social, emotional and existential, are identified in research, policy and practice. Do these categories reflect the language used by older adults to describe their experiences of loneliness? We use data from the 2018 BBC Loneliness Experiment and focus upon lonely adults aged 60 and older, living in the UK and with a maximum score of 9 on the UCLA loneliness scale. 1619 participants meet these criteria, 1480 provided a response to the question ''What does loneliness mean to you?" Participants ages ranged from 60-94; 90% aged 60-74 and 38% male. Free text answers ranged from 1-189 words, included both subjective (feeling alone) or objective (being alone) words and described social (no one to talk to), emotional (lack of closeness) and existential (lack of purpose) loneliness. Lonely older adults 'talk' about the three different types of loneliness singly or in combinations when explaining what loneliness means to them. We conclude that:-(a) existential loneliness merits more attention as it is less prominent in research compared with other types of loneliness and (b) lonely older adults describe different types of loneliness in the same answer. Introduction: Phone-based support programs are increasingly being used as a solution for those experiencing loneliness. However, less is known about what aspects of these support programs are most helpful to participants and even less known about the staff and volunteer who work in these programs.

EVALUATING A PHONE-BASED SUPPORT PROGRAM TO ADDRESS LONELINESS: LESSONS LEARNED FROM PARTICIPANTS AND STAFF
Methods: Mixed methods structured surveys of participants (N=247 baseline, N=147 follow-up), and in-depth qualitative interviews of both participants (N=15, and staff=23).
Results: We present the results from the qualitative interviews with a focus on what barriers and facilitators are to implementing a phone-based support intervention, particularly for older adults experiencing loneliness. Preliminarily, 77% of staff and volunteers felt more connected themselves through their role in the phone-support program. 100% of staff also believe the callers feel less lonely as a result of using the line, and 80% feel they create a meaningful relationship with callers. Themes included and overall sense of need for expansion of these services, while better understanding the optimal length and frequency of calls. Consistent with staff responses, amongst callers, 90% fell more socially connected because they use the telephone support line. Similarly, to staff and volunteers, participants felt their needs were met during calls, but wished the length of calls could be flexible. This demonstrates that the line is beneficial to both participants and staff. There is high satisfaction on the quality of the calls and the connections made, but emerging themes suggest a need to scale services to meet demand at all hours and allow for flexibility in length of calls. Social isolation is prevalent among community dwelling older adults. Low income older adults living in subsidized housing may have increased risk for social isolation. To examine resident experiences and perspectives relating to their social connections during the COVID-19 pandemic, we conducted semi-structured interviews with 13 older adults (62+) who are English, Spanish, and Mandarin speaking recruited from a large non-profit affordable housing organization with communities in 22 states. Twelve housing communities were identified based on distributions of socio-demographic factors and prevalence of self-reported social isolation l in the housing community's annual survey of residents in order to maximize site diversity. We used qualitative thematic analysis methods to examined participants' views about their social connections before and during the COVID-19 pandemic, as well as their personal and the housing community's strategies to mitigate experiences of social isolation. Emerging themes include loss of common facilities and opportunities to socialize with other residents due to COVID-19 restrictions, and increased use of technology to stay connected.